Healthcare Provider Details

I. General information

NPI: 1265165344
Provider Name (Legal Business Name): NICOLET CHARICE HENDERSON LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-1542
US

IV. Provider business mailing address

4573 MACARTHUR BLVD NW APT 301
WASHINGTON DC
20007-4283
US

V. Phone/Fax

Practice location:
  • Phone: 202-724-7666
  • Fax:
Mailing address:
  • Phone: 615-582-7343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200002134
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: